BP II? Meds & Depression?
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Q:  BP II?  Meds & Depression?

two psychiatrists have diagnosed me with bipolar disorder type 2, but after a recent stay at ohio state's university's hospital neuropsyciatric ward as well as a continuing four weeks (so far) of all day care, they are ruling this out. the only diagnosis they have held to is GAD with panic attacks and agoraphobia. i have taken the mmpi II in december of 1999 as well as last week. i am still peaking at depression and axiety. are they afraid to give me an anti depressant as i will cycle faster if i am bi-polar type 2 or will my current medications eventually take care of the depression. i have reached a level of 47 as of 5 days ago by taking 500mg depacote per day. i also take 50 mg. of seroquel 25am and 25pm. this was just cut back to reduce tiredness as i am also on 1mg. klonopin 3x day =3mg. per day.               

now, i guess if i had to pinpoint it my question would be ...and i don't know if you are allowed to do this but...1.do you think i could be bi-polar type 2?   and 2. will the meds i am on eventually clear up the depression? also wondering what your thoughts are on cognitive behavioral therapy, i don't seem to be applying it in the heat of the moment.

would love a reply, just feel i have been doing everything as ordered for past two years and nothing has changed.

thank you,


dear christine -- 
You're right, it would not be good for me to offer a diagnosis; but suffice it to say that yes, you "could" be bipolar II, as this diagnosis is often disagreed upon by very competent psychiatrists.  And GAD looks mighty similar, as I tried to show in a table on my website
comparing GAD and BPII.  Have a look at that.  

At this point you're at the stage where "yes or no, bipolar or not?" is no longer the question.  Rather, as you point out, the question is whether there's enough reason to suspect BP II to shy away from antidepressants at this point.  If you do indeed have something like bipolar disorder, then usually the way to treat cycles of depression is to stop the cycles, rather than to treat the depression directly.  

Your dose and level of Depakote are on the low side, just below 50, where we usually shoot for 50 or more; going up to as high as 125.  But you'll have to watch out for weight gain as the dose goes up, whereas that is usually not a problem at your current dose.  (Appetite increases dramatically; if you don't get that you probably won't gain weight from Depakote).  

So usually in your circumstance my general game-plan is to keep increasing mood stabilizers or adding another one until the cycling stops; then turn to whatever symptoms remain, which is usually few.  At that point the cognitive therapy could be useful; before then, as you may be discovering, in my experience it has been tough for my clients to really use the tools.  A CBT pro' might be able to make it work, but I usually can't, and I'm a pretty big CBT fan for anxiety symptoms (but I usually reserve it for when they aren't cycling...).  

Dr. Phelps


Published February, 2002


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